Provider Demographics
NPI:1114037025
Name:COBB, PAMELA KEY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:KEY
Last Name:COBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 GLENMONT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3208
Mailing Address - Country:US
Mailing Address - Phone:614-263-7361
Mailing Address - Fax:
Practice Address - Street 1:308 GLENMONT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3208
Practice Address - Country:US
Practice Address - Phone:614-263-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.058777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0753233Medicaid
OHBC9496729OtherDEA
OH0753233Medicaid